Did my blood test results suggest I drink too much?
Simon gets blood tests and professional medical opinion on his alcohol consumption. Here we summarise the full and frank discussion he has with his doctor
If you've been following my travails this year, you'll recall that during January I documented every alcoholic drink I consumed, as an alternative response to those preaching the gospel of Dry January. I took a look at the month and offered up some analysis here. To summarise very broadly, yes I drink way over most northern European government recommendations - but at the same time neither I nor any of my colleagues seemed to feel that this is a problematic level.
But there was unfinished business. I wanted the opinion of a medical professional. Could I really be sure that drinking around 36 UK units per week is safe? Or least not so terrifyingly life-shortening that I could countenance continuing? Enter my doctor friend: Basile Weijters is a huisarts (the equivalent of a GP in the UK) who lives in Rotterdam and runs a practice in Dordrecht. I asked if he'd be willing to take a look at the data I amassed during January, and give his professional opinion about it. Not only was he willing, he also suggested a complete set of blood tests to check for liver function and other related matters. I was game - if ever so slightly apprehensive.
Once we got the blood test results back, we got together and discussed the implications. I put a number of questions to Basile and we had a full and frank discussion about the challenges of matching up public health policies with individual lifestyles.
Interpreting the results
(Note - the blood tests were done in the Netherlands, so you'll see the results use Dutch terminology. I use English terminology in the text, and in all cases it's similar enough to be obvious)
The haemoglobin check is just to make sure that I'm not anaemic. No issues here.
The value for creatinine indicates the renal (kidney) function. In my case it's also normal, which indicates proper kidney function.
Alkaline phosphatase, ASAT, ALAT and gamma-GT are enzymes found in the liver. Basile notes "If the liver is damaged by medication, alcohol or a virus then you see that liver cells are dying and those values will be elevated. Specifically for alcohol you see the gamma-GT values being elevated."
Basile commented "Your values are well within the boundaries for normal - so your liver seems to be healthy." (At this point I heaved a big sigh of relief).
We then took a look at cholesterol values, as excess alcohol consumption often translates into weight gain and thus raised cholesterol levels.
My total cholesterol level and levels of triglycerides were also good. Basile noted that the figure for high-density lipoprotein cholesterol (HDL-C, the so-called "good cholesterol") was "higher than I normally see in my patients". The same was true for my low-density cholesterol (LDL-C, the "bad" cholesterol). In the latter case, my level is marginally over the healthy limit (2.93 mmol/l where the healthy limit is suggested as up to 2.5 mmol/l).
I asked Basile if this was cause for worry, or if it could be due to alcohol consumption. His answer was no in both cases. He explained "Whats important is the ratio between the total cholesterol and HDL-C, which needs to be as low as possible (preferably between 4 - 7). Yours is 2.7 so it's a favourable profile." He added that "If you drink too much alcohol then the liver gets fatty, your HDL goes down and your LDL goes up". He pointed out that the figure for triglycerides would also increase were this to be the case.
I double-checked the LDL-C figure (as it was the only one outside the normal, healthy range). The American Heart Organisation classifies my value for LDL-C as "Near optimal LDL level, corresponding to higher rates for developing symptomatic cardiovascular disease events" (Source: wikipedia). Within context it doesn't look like anything to be concerned about.
Basile's overall comment about the results was "I think it's a normal blood result with no signs of any liver damage."
What is a healthy level of alcohol consumption?
I asked Basile for his take on my January alcohol consumption (an average of 36 UK units a week). He said "I saw your consumption for January. People rarely show me that level of detail. When they smoke they know exactly how many cigarettes they smoke but with drinking it gets a bit more shady." He added that clearly I drink more than the recommended limits, whether in Netherlands or UK (or many other European nations).
However he then added "I cannot verify how much people drink, so I only look at it if there's a problem - for example if someone is overweight, or has mood disturbances". He added that "when we run blood tests because somebody is tired and you see elevated liver values, then it gets way more concrete. If that was the case, I would strongly recommend you to reduce the consumption of alcohol."
The Netherlands is a famously liberal country, and Basile's take reflects that. He says "It's not my core business to tell people how much they should drink or smoke. Thus there's no specific advice I would give in your case". He did however add that based on his experience "I think it's more or less on average what a Dutch man of your age would drink. I'm sure I have a load of patients who drink way more than that!"
We then talked about whether there were any worrying trends or patterns in my alcohol consumption. Basile's response was heartening: "On the contrary, I noticed that on Sundays you drink very little and on Mondays you don't drink. I didn't see you really binge drinking on any days, so for me there's nothing worrying at all. People who are dependent don't tend to have those days [where they don't drink]."
We then headed into more rocky territory. I pointed out that in my view the very low recommended limits in the UK and Netherlands - and the advice in both countries that it is best to completely abstain from alcohol - could be counterproductive. Basile presented two conflicting points of view here - the official line and the common-sense view.
"From a public health standpoint, of course drinking a moderate amount of alcohol is associated with higher risks of cancer or raised cholesterol levels. " he says. But he adds that there are nuances: "Alcohol comes in different ways. You probably see that people who drink high end wines tend to eat healthier food, whereas people who buy cheap lager from the supermarket are eating fast food".
Nevertheless, he believes that public health organisations (such as the RIVM in the Netherlands and the Chief Medical Officer in the UK) have to stick to extremely low recommended limits. We discuss the UK's dramatic lowering of its recommended limits in 2016, and he notes that "It's about how limits are communicated. You can say 'you shouldn't drink more than x' but that isn't necessarily helpful. Or you can say 'if you drink more than x then there are increased risks of such and such disease". Ultimately, Basile points out, all governments can do is to advise. Everyone has to make their own mind up. "We all know that smoking, drinking alcohol and walking around dirty cities is bad for you. But many of us still choose to do these things."
His personal view is that "tobacco, sugar and alcohol should be taxed more heavily", to dissuade people. But he acknowledges that though the anti-alcohol lobby is strong, the corporate lobbyists behind the sale of these products are even stronger.
Basile was very clear at all times that a number of different factors have to be considered when it comes to what constitutes a healthy lifestyle or not. Weight, height, blood-pressure, diet and exercise are all critical factors. "Just the alcohol by itself doesn't say it all" he notes. In my case, my weight/height and thus BMI are healthy, as is my diet (no junk food, no soft drinks, no ready meals, most food is home-cooked). I exercise regularly.
Basile adds that "It's also dependent on how well your body tolerates alcohol." He mentions the classic examples of Asians and Aboriginals - two ethnic groups that by-en-large do not tolerate alcohol well, and whose bodies cannot process it with the same efficiency that many westerners can. "In your case, your body is used to processing alcohol, and there is no damage to your liver".
Whilst Basile's message was overwhelmingly positive, I had to consider the gorilla in the room: however healthy my liver is, there's still the increased risk of cancer to consider. This is where the waters become very muddied. The UK government and its various medical arms present a very stark picture of even moderate alcohol consumption causing increased risk of contracting up to seven different types of cancer. But the level of that increased risk, and its true implications, are disputed - and may be as low as 1-2 percentage points.
Furthermore, research into whether different types of alcohol (wine versus beer versus spirits) have a different effect is thin on the ground. Nuance is lacking, scaremongering is rife.
Given that the increased risk of contracting cancer as a result of moderate alcohol consumption is low (and almost certainly under 5%), I think I can live with that. The amount of enjoyment, intellectual stimulus and conviviality that I gain from the consumption of wine (and other alcohols) is worth it. I do of course also live in a polluted city. At least I don't smoke.